Gender, Disability and Development

Gender, Disability and Development

<p style="text-align: right;"><strong>Yasmine Bencherif</strong></p>
<p style="text-align: right;"><strong>Master 2 in Development Economics and International Project Management (DEIPM)</strong></p>
<p style="text-align: right;"><strong>Université Paris Est Créteil (UPEC) and Université Gustave Eiffel (UGE)</strong></p>
<p style="text-align: right;"><em>Article published as part of Wikigender University</em></p>

<h3><em><strong>Context</strong></em></h3>
In this article we explore the relationship between disability and gender. Divided into three parts, the first section compiles research on this intersectionality, describing the gendering process through the lens of a disability. Section two distinguishes between masculine and feminine coping mechanisms and highlights findings on gender differences in healthcare services. The final section, section three, takes on a global approach and compares treatment and accessibility for disabled persons between developed and developing regions. The purpose of this article is to showcase the potential for gendered research to act as a catalyst in healthcare and development.
<h3><em><strong>Section I. The Intersection between Gender and Disability</strong></em></h3>
<h4><em>Section 1.1: Defining Gender</em></h4>
According to the World Health Organization (WHO), gender is the socially constructed behaviours, norms and expectations associated with being a woman, man, boy or girl<a href="#_ftn1" name="_ftnref1">^[1]</a>. Societal expectations for gender are typically rooted in a person’s biological sex, even if sex and gender do not explicitly overlap. We note that the nature of these expectations has varied over time and continues to vary from culture to culture.
<h4><em>Section 1.2: Defining Disability </em><em> </em></h4>
Disability is defined as any limitation of the body or mind that makes it more difficult for a person to participate and interact with the world around them<a href="#_ftn2" name="_ftnref2">^[2]</a>. The WHO is careful to note that disability is a natural element of being human, given that almost everyone experiences either a temporary or permanent disability at some point in their lifetime<a href="#_ftn3" name="_ftnref3">^[3]</a>. Disability encompasses limitations in the capacity to see, move, think, remember, learn, communicate, hear, or engage socially, among other functions. This non-exhaustive list makes clear that some disabilities are more visible, and in some cases more impairing, than others. The implications resulting from a disability can be a product not only of the type of impairment but also the severity and onset of the condition.
<h4><em>Section 1.3: Intersectionality Between Gender and Disability </em></h4>
Theories on the relationship between disability and gender seek to address the ways in which disability affects the gendering process as well as to identify a disability’s impact on the experience of gender. Sociologists and anthropologists have concluded that disability is a social condition with many arguing that the greatest impediments brought by disability are rooted in stigmatization<a href="#_ftn4" name="_ftnref4">^[4]</a>.  The stigma attributed to disability limits an individual’s capacity to enact gender in the “appropriately” masculine and feminine constructs, and this is increasingly true the more visible and severe the condition. For example, consider masculine constructs of strength and physical dominance and how a physical disability could limit an individual from displaying these characteristics “appropriately”. A mental disability can also greatly implicate an individual’s display, interpretation of, or capacity to understand gender norms. The degree to which a disability implicates gender performance is impacted not only by the severity of the condition but also by the age of onset. The earlier the onset of the disability the more likely the individual is to interpret gender socialisation through the lens of the condition and its resulting stigmas.

Researchers have identified the distinction between men and women’s experience of disability as “sexism without the pedestal” for women and the “erosion of male privilege” for men.<a href="#_ftn5" name="_ftnref5">^[5]</a> From this assertion, we yield that stigmatization surrounding disability is strongly intertwined with the gendering process. Gerschick (2000) identifies three social dynamics which contextualize gender within disabilities: (1) the stigma assigned to disability, (2) gender as an interactional process and (3) the importance of the body to enact gender. In the following section, we expand on Gerschick’s third social dynamic.
<h4><em>Section 1.4: Stigmatization and Disability</em></h4>
Anthropologist Robert Murphy in his novel <em>The Body Silent: The Different World of the Disabled</em> describes stigmatization as the essence of disability (1990, 113). From the same token, we extrapolate that gender and its resulting stigmas are impacting on the perception and experience of one’s disability. Testimonials from disabled persons repeatedly cite experiences of marginalisation, discrimination, isolation and devaluation.<a href="#_ftn6" name="_ftnref6">^[6]</a> In the following section, we explore the “double disadvantage” imposed on disabled women.
<h4><em>Section 1.5: Double Disadvantage </em></h4>
In the above sections we assert that disability is a largely interactional process, and that much of the experience of a disability is attributed to social expectations and attached stigmas. Further, we purport that this stigmatization is not fixed but rather varies from person to person based on their perceived experience, ability to meet expectations, as well as the severity and onset of their condition.

Women that are disabled suffer from a “double disadvantage” of sorts where they are subjected not only to the stigmatization (and resulting discrimination) associated with being disabled but also that of being a woman. The burden of a double disadvantage is evidenced in the disproportionate likelihood for disabled women to be sexually assaulted as well as the maintenance of a gender pay gap across cohorts of disability relatively equal in severity.<a href="#_ftn7" name="_ftnref7">^[7]</a>
<h3><em><strong>Section II. Coping Mechanisms and Healthcare Treatments</strong></em><strong> </strong></h3>
<h4><em>Section 2.1: Gendered Differences in Coping Mechanisms </em></h4>
Studies on coping mechanisms and styles identify strong distinctions between visually impaired men and women, which suggests that women may face greater difficulty in the experience of their disability compared to their male counterparts. For example, an assessment of coping mechanisms for visual impairment found that women experienced greater mental distress and dissatisfaction with their health and psychological well-being. A study measuring participants’ perceptions of their ability to understand and communicate, get around, care for themselves, get along with people, perform household tasks and participate in society found that women fared worse in all domains with the exception of getting along with others and coping in school activities.<a href="#_ftn8" name="_ftnref8">^[8]</a>
<h4><em>Section 2.2: Gendered Differences in Disabilities</em></h4>
Gendered differences in disability are evidenced not only by the effectiveness of coping strategies but also by gendered discrepancies in prevalence. Studies find that women have either a significantly higher prevalence or worsened experience in visual impairment, psychological disorders and physical disabilities.
<h4><em>Section 2.2.1: Visual Impairment</em></h4>
Even though the majority of visually impairing conditions are either preventable or treatable, women account for 64% of global blindness. When adjusted for age, women’s prevalence is still 39% higher than men.<a href="#_ftn9" name="_ftnref9">^[9]</a> This suggests potential failures in the delivery of equitable access to health services.

Studies find that trachoma, a bacterial infection leading to blindness or visual impairment, is not linked with biological sex; however, women are between 2 to 4 times more likely to be infected than men. Women are also twice as likely to develop serious trichiasis compared to men. Significantly higher prevalence of trachoma in women is linked with increased exposure to infection resulting from traditional responsibilities in childcare and hygiene-related tasks. Studies also highlight differences in the quality of eye care administered between men and women, likely as a result of cultural norms pertaining to gender.<a href="#_ftn10" name="_ftnref10">^[10]</a>
<h4><em>Section 2.2.2: Psychological Health</em></h4>
The WHO asserts that there are no sex-driven explanations for gendered differences in the prevalence, onset and course of psychological disorders. Discrepancies are attributed to the interaction between biological and social vulnerability, gender roles and gender-based violence which may account for higher prevalence and comorbidity among women.<a href="#_ftn11" name="_ftnref11">^[11]</a>

These implications on the likelihood of suffering from a psychological disorder suggest that a woman’s exposure to and capacity to cope with a disability is negatively impacted by the gendering process. Other studies point to gender bias in measures of psychological well-being, with assessments favoring gender-masculine traits to evaluate as psychologically well.<a href="#_ftn12" name="_ftnref12">^[12]</a>
<h4><em>Section 2.2.3: Physical Disability </em></h4>
Studies on the interactive process between appraisal of the self and depressive symptoms in the physically disabled highlight the distinction between men and women’s coping experiences. Women with physical disabilities tend to exhibit similar experiences in comparison to women with other disabilities. Contrastingly, men with physical disabilities tend to experience psychological distress through their self-esteem evaluations as well as a sense of devaluation both of which strongly indicate depressive symptoms.<a href="#_ftn13" name="_ftnref13">^[13]</a> These findings suggest that the needed attention on gender implications may vary from disability to disability.
<h4><em>Section 2.3: Gender Disparities in Treatment </em></h4>
Sex differences in the prevalence or severity of a condition can also be the result of some extra environmental cause, like a systemic failure in healthcare. For example, the increased likelihood for a woman to suffer from a preventable or treatable condition can be due to limited or biased access to treatment. Gender has the potential to limit access to treatment if the contextual norm impacts perceptions of vulnerability, value, autonomy or trust.

The lens through which care-providers communicate and make recommendations for their patient is equally as important as the patients’ willingness to be treated. Both of these elements are susceptible to waiver in the presence of gender bias. For example, studies find that women are much less likely to seek treatment than men. After controlling for differences in demographics, social factors, health needs and economic access, studies find that women use hospital services 21% less than men. <a href="#_ftn14" name="_ftnref14">^[14]</a> This study suggests that from a caregiver’s perspective this could have to do with a reluctance to subject women to riskier treatment options. From a patient’s perspective, women may be less likely to accept intensive care due to their own caregiving responsibilities. These findings suggest that repositioning childcare as an androgynous quality could greatly improve women’s experiences in healthcare treatment.
<h3><em><strong>Section III. Global Approach to Accessibility and Treatment </strong></em></h3>
The studies referenced in this article feature case studies from middle-income and low-income countries in Africa, Asia and the Middle East. In this section, we expand on varying approaches to disability in developing regions.

In a collaborative report on disability, the WHO and World Bank (WB) make a strong distinction between developed and developing countries and their relationships with disability. Although developed countries typically offer greater assistance, disabled persons in developed countries are still typically worse off in their educational and labour market prospects than non-disabled persons with the exception of Norway, Slovakia and Sweden. In developing countries, the <em>World Health Survey</em> identifies households with disabled members as having significantly higher healthcare expenditures than households without disabled members.

Despite a universally higher likelihood to be impoverished if disabled, developing nations have notably insufficient services and provisions for people with disabilities in comparison with developed nations. The World Report on Disability compiles studies across regions in Africa and Asia which indicate a slew of unmet needs in health, welfare, aid, equipment, education and employment. For example, in Malawi, Namibia, Zambia and Zimbabwe less than 50% of the aforementioned needs are met. National studies in Morocco cited limited access to services as one of the most critical barriers for the disabled. Likewise, national studies in China found that approximately 1 in every 4 disabled persons receives no assistance of any kind for their disability.<a href="#_ftn15" name="_ftnref15">^[15]</a>

According to the Global Gender Gap Report (2020), countries in the Middle East, South Asia, and Sub-Saharan Africa scored amongst the lowest in gender equality.<a href="#_ftn16" name="_ftnref16">^[16]</a> Current research on the intersectionality between gender and disability does not touch on the discrepancy between developed and developing regions. We believe that the parallels in gender equitability and disability inclusion across development highlight an interesting potential channel for policy reform.

We recommend the inclusion of gender education in existing programs for disability inclusion as well as components addressing disability and access to healthcare in current gender-equality agendas. Global commitments like the Inclusive Education Initiative and the Disability-Inclusive Education in Africa Program have the potential to shift, or otherwise reframe, gender narratives which are worsening outcomes for disabled men and women. <a href="#_ftn17" name="_ftnref17">^[17]</a> For example, UNESCO has encouraged countries to advocate for inclusive educational policies, programmes and practices so that children with diverse learning challenges can have improved outcomes<a href="#_ftn18" name="_ftnref18">[18]</a>. In response to the COVID-19 pandemic, educational reform and inclusivity have become major areas of focus in the recovery process. Partnerships based in inclusive, sustainable reform will be key to address many of the issues worsened by the pandemic including quality and accessible education. Implementing reforms in line with the vision of building back a more inclusive world will depend heavily on diversity and empowering minority groups like women and the disabled. The partnership between UNESCO and Global Education Coalition leans into this recovery opportunity and emphasizes the role of the Global Action on Disability Network (GLAD) in their decision-making processes and discussions<a href="#_ftn19" name="_ftnref19">[19]</a>.

As mentioned before, disability is a condition innate to the human experience whether it occurs temporarily or permanently, through early or late onset. Of the same token, gender and its pervasive influence on our perception and behaviors is another often overlooked yet universal experience. Incorporating disability in gender inclusive efforts serves more than just the disabled, and this perspective should be incorporated in policy reform and debate. We suggest that the intersectionality between disability and gender belong at the forefront of policy agendas to serve both developed and developing contexts.
<h3><em>Bibliography</em></h3>
Badr HE, Mourad H Assessment of visual disability using the WHO disability assessment scale (WHO-DAS-II): role of gender British Journal of Ophthalmology 2009;93:1365-1370.

Brown, R.L. Psychological Distress and the Intersection of Gender and Physical Disability: Considering Gender and Disability-Related Risk Factors. Sex Roles 71, 171–181 (2014). <a href="https://doi-org.ezproxy.u-pec.fr/10.1007/s11199-014-0385-5">https://doi-org.ezproxy.u-pec.fr/10.1007/s11199-014-0385-5</a>

Cameron, K. A., Song, J., Manheim, L. M., & Dunlop, D. D. (2010). Gender disparities in health and healthcare use among older adults. Journal of women’s health (2002), 19(9), 1643–1650. <a href="https://doi.org/10.1089/jwh.2009.1701">https://doi.org/10.1089/jwh.2009.1701</a>

Center for Disease Control and Prevention. (2020, September 15). Disability and Health Overview | CDC. <a href="https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html">https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html</a>

Doyal L, Das-Bhaumik RG. Sex, gender and blindness: a new framework for equity. BMJ Open Ophthalmology 2018 3:e000135. doi:10.1136/bmjophth-2017-00135

Fine, M., & Asch, A. (1988). Disability beyond stigma: Social interaction, discrimination, and activism. Journal of Social Issues, 44(1), 3–21. <a href="https://psycnet.apa.org/doi/10.1111/j.1540-4560.1988.tb02045.x">https://doi.org/10.1111/j.1540-4560.1988.tb02045.x</a>

Gerschick, T. (2000). Toward a Theory of Disability and Gender. Signs, 25(4), 1263-1268. Retrieved January 29, 2021, from <a href="http://www.jstor.org/stable/3175525">http://www.jstor.org/stable/3175525</a>

Int. J. Environ. Res. Public Health 2019, 16(19), 3531; <a href="https://doi.org/10.3390/ijerph16193531">https://doi.org/10.3390/ijerph16193531</a>

UNESCO. (2021b, May 4). GEM 2020: Ensuring a focus on inclusion, equity, and gender equality. <a href="https://en.unesco.org/news/gem-2020-ensuring-focus-inclusion-equity-and-gender-equality">https://en.unesco.org/news/gem-2020-ensuring-focus-inclusion-equity-and-gender-equality</a>

UNESCO. (2021, April 9). Education for persons with disabilities. <a href="https://en.unesco.org/themes/inclusion-in-education/disabilities">https://en.unesco.org/themes/inclusion-in-education/disabilities</a>

World Economic Forum. (2020). Global Gender Gap Report 2020. <a href="http://www3.weforum.org/docs/WEF_GGGR_2020.pdf">http://www3.weforum.org/docs/WEF_GGGR_2020.pdf</a>

The World Bank IBRDA + IDA. (2021). Disability Inclusion Overview. World Bank. <a href="https://www.worldbank.org/en/topic/disability#3">https://www.worldbank.org/en/topic/disability#3</a>

World Health Organization. (2020, January 27). Disability. <a href="https://www.who.int/health-topics/disability#tab=tab_1">https://www.who.int/health-topics/disability#tab=tab_1</a>

World Health Organization. (2019, June 19). Gender and health. World Health Organization / Home / Health Topics / Gender. <a href="https://www.who.int/health-topics/gender#tab=tab_1">https://www.who.int/health-topics/gender#tab=tab_1</a>

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World Health Organization (WHO). (2002). Gender and mental Health. <a href="https://www.who.int/gender/other_health/genderMH.pdf">https://www.who.int/gender/other_health/genderMH.pdf</a>



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<a href="#_ftnref1" name="_ftn1">^[1]</a> World Health Organization. (2019, June 19). Gender and health. World Health Organization / Home / Health Topics / Gender. https://www.who.int/health-topics/gender#tab=tab_1

<a href="#_ftnref2" name="_ftn2">[2]</a> Center for Disease Control and Prevention. (2020, September 15). Disability and Health Overview | CDC. https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html

<a href="#_ftnref3" name="_ftn3">^[3]</a> World Health Organization. (2020, January 27). Disability. https://www.who.int/health-topics/disability#tab=tab_1

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<a href="#_ftnref4" name="_ftn4">^[4]</a> Gerschick, T. (2000). Toward a Theory of Disability and Gender. Signs, 25(4), 1263-1268. Retrieved January 29, 2021, from http://www.jstor.org/stable/3175525

<a href="#_ftnref5" name="_ftn5">^[5]</a> Fine, M., & Asch, A. (1988). Disability beyond stigma: Social interaction, discrimination, and activism. Journal of Social Issues, 44(1), 3–21. <a href="https://psycnet.apa.org/doi/10.1111/j.1540-4560.1988.tb02045.x">https://doi.org/10.1111/j.1540-4560.1988.tb02045.x</a>

<a href="#_ftnref6" name="_ftn6">^[6]</a>See footnote 5 reference.

<a href="#_ftnref7" name="_ftn7">^[7]</a>See footnote 5 reference.

<a href="#_ftnref8" name="_ftn8">^[8]</a>Badr HE, Mourad H Assessment of visual disability using the WHO disability assessment scale (WHO-DAS-II): role of gender British Journal of Ophthalmology 2009;93:1365-1370.

<a href="#_ftnref9" name="_ftn9">^[9]</a> See footnote 8 reference.

<a href="#_ftnref10" name="_ftn10">^[10]</a> Doyal L, Das-Bhaumik RG. Sex, gender and blindness: a new framework for equity. BMJ Open Ophthalmology 2018 3:e000135. doi:10.1136/bmjophth-2017-00135

<a href="#_ftnref11" name="_ftn11">^[11]</a> World Health Organization (WHO). (2002). Gender and mental Health. https://www.who.int/gender/other_health/genderMH.pdf

<a href="#_ftnref12" name="_ftn12">^[12]</a> Int. J. Environ. Res. Public Health 2019, 16(19), 3531; <a href="https://doi.org/10.3390/ijerph16193531">https://doi.org/10.3390/ijerph16193531</a>

<a href="#_ftnref13" name="_ftn13">^[13]</a> Brown, R.L. Psychological Distress and the Intersection of Gender and Physical Disability: Considering Gender and Disability-Related Risk Factors. Sex Roles 71, 171–181 (2014). https://doi-org.ezproxy.u-pec.fr/10.1007/s11199-014-0385-5

<a href="#_ftnref14" name="_ftn14">^[14]</a> Cameron, K. A., Song, J., Manheim, L. M., & Dunlop, D. D. (2010). Gender disparities in health and healthcare use among older adults. Journal of women’s health (2002), 19(9), 1643–1650. https://doi.org/10.1089/jwh.2009.1701

<a href="#_ftnref15" name="_ftn15">^[15]</a> World Health Organization [and] The World Bank. (2011). World report on disability. Geneva, Switzerland :World Health Organization,

<a href="#_ftnref16" name="_ftn16">^[16]</a> World Economic Forum. (2020). Global Gender Gap Report 2020. http://www3.weforum.org/docs/WEF_GGGR_2020.pdf

<a href="#_ftnref17" name="_ftn17">^[17]</a> The World Bank IBRDA + IDA. (2021). Disability Inclusion Overview. World Bank. https://www.worldbank.org/en/topic/disability#3

<a href="#_ftnref18" name="_ftn18">[18]</a> UNESCO. (2021, April 9). Education for persons with disabilities. https://en.unesco.org/themes/inclusion-in-education/disabilities

<a href="#_ftnref19" name="_ftn19">[19]</a> UNESCO. (2021b, May 4). GEM 2020: Ensuring a focus on inclusion, equity, and gender equality. https://en.unesco.org/news/gem-2020-ensuring-focus-inclusion-equity-and-gender-equality

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